Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia.
J Arthroplasty. 2024 Sep;39(9S2):S374-S379. doi: 10.1016/j.arth.2024.03.022. Epub 2024 Mar 18.
Porous tantalum metaphyseal cones may facilitate reconstructions of severe bone defects during revision total knee arthroplasty (TKA), but there remains a paucity of data on their outcomes at mean 5 years of follow-up. This study reports the component survivorship, patient satisfaction, functional outcomes, radiographic osseointegration, and complications of revision TKA with porous tantalum metaphyseal cones at mid-term (mean 5-year) follow-up.
This study included 152 patients who had a mean age of 66 years (range, 33 to 86 years) undergoing revision TKA with porous tantalum metaphyseal cones. Indications for surgery included aseptic loosening (n = 87, 57.3%), second-stage reimplantation for infection (n = 42, 27.6%), osteolysis with well-fixed components (n = 20, 13.2%), and periprosthetic fracture (n = 3, 2.0%). Component survivorship, clinical outcomes, radiographic outcomes, and any complications were recorded. The mean follow-up time was 5.6 years (range, 2.2 to 13.7).
Survivorship was 100% when the end point was revision of the metaphyseal cone (no cones were revised) and 83.8% (95% confidence interval: 77.9 to 90.2%) when the end point was reoperation for any reason at 5-year follow-up. Reoperations were performed for infection (n = 10), instability (n = 4), periprosthetic fracture (n = 2), and quadriceps rupture/dehiscence (n = 3). The mean patient satisfaction score was 78.8 ± 11.3 and the mean Forgotten Joint Score was 62.2 ± 16.7 at the final follow-up. The preoperative median University of California at Los Angeles score improved from 2 (interquartile range 2 to 3) to 6 points (interquartile range 5 to 6) (P < .001), and the preoperative Oxford knee score improved from 15.2 ± 3.8 to 39.4 ± 5.1 points (P < .001) at the final follow-up. All metaphyseal cones showed radiographic evidence of osteointegration without any subsidence or loosening.
Porous tantalum metaphyseal cones enabled robust reconstructions of severe femoral and tibial bone defects during revision TKA. These reconstructions were associated with excellent survivorship, improvements in functional outcomes, and reproducible radiographic osseointegration at mean 5-year follow-up. The most common reasons for reoperation were infection and instability.
多孔钽皮质骨扩张器可促进翻修全膝关节置换术（TKA）中严重骨缺损的重建，但在平均 5 年随访时，其结果数据仍然很少。本研究报告了在中期（平均 5 年随访）时，使用多孔钽皮质骨扩张器进行翻修 TKA 的患者的假体生存率、患者满意度、功能结果、影像学骨整合和并发症情况。
本研究纳入了 152 名平均年龄 66 岁（范围 33 至 86 岁）的患者，他们接受了多孔钽皮质骨扩张器翻修 TKA。手术指征包括无菌性松动（n=87，57.3%）、二期再植入治疗感染（n=42，27.6%）、有固定良好的假体的溶骨症（n=20，13.2%）和假体周围骨折（n=3，2.0%）。记录了假体生存率、临床结果、影像学结果和任何并发症。平均随访时间为 5.6 年（范围 2.2 至 13.7 年）。
当终点为皮质骨扩张器翻修（无扩张器翻修）时，生存率为 100%；当终点为因任何原因在 5 年随访时再次手术时，生存率为 83.8%（95%置信区间：77.9%至 90.2%）。再次手术的原因包括感染（n=10）、不稳定（n=4）、假体周围骨折（n=2）和股四头肌断裂/裂开（n=3）。末次随访时，患者满意度平均评分为 78.8±11.3，遗忘关节评分平均为 62.2±16.7。术前加州大学洛杉矶分校评分中位数从 2 分（四分位距 2 至 3）改善至 6 分（四分位距 5 至 6）（P＜0.001），术前牛津膝关节评分从 15.2±3.8 改善至 39.4±5.1 分（P＜0.001）。所有皮质骨扩张器均显示出影像学骨整合的证据，无下沉或松动。
多孔钽皮质骨扩张器可在翻修 TKA 中对严重的股骨和胫骨骨缺损进行强有力的重建。这些重建与出色的假体生存率、功能结果的改善以及平均 5 年随访时可重复的影像学骨整合相关。再次手术的最常见原因是感染和不稳定。
